Provider Demographics
NPI:1043641830
Name:CYRUS HOME LLC
Entity Type:Organization
Organization Name:CYRUS HOME LLC
Other - Org Name:CYRUS HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUEASE
Authorized Official - Middle Name:
Authorized Official - Last Name:CYRUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-217-0015
Mailing Address - Street 1:3101 GINGER LAKE CT
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-5738
Mailing Address - Country:US
Mailing Address - Phone:919-217-0015
Mailing Address - Fax:919-404-8252
Practice Address - Street 1:3101 GINGER LAKE CT
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597-5738
Practice Address - Country:US
Practice Address - Phone:919-217-0015
Practice Address - Fax:919-404-8252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL092262320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities